Vitamin D and the Risk for Type 2 Diabetes in People with Prediabetes
ACP Journals: Annals of Internal Medicine: Published
on February 2023
In this systematic review and
meta-analysis, the authors assessed whether vitamin D administration decreases
the risk for diabetes in individuals with prediabetes.
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Combining data from three
randomized trials, the authors demonstrated that vitamin D reduced the risk of
diabetes by 15% and increased the likelihood of regression to normal glucose
regulation.
Vitamin D may be effective in
decreasing the risk for diabetes in adults with prediabetes.
For patients with prediabetes,
consider checking 25-hydroxy vitamin D levels and supplement to get levels
between 50 to 60 ng/mL (125–150 nmol/L).
The greatest reduction (76%) was
seen in patients with a serum 25-hydroxy vitamin D level of 50 ng/mL (125 nmol/L).
Consider supplementing towards this serum level. Of note, 1000 IU of vitamin D3
will raise its serum levels by about 8 to 10 ng/mL.
If you had a patient with a serum
level of 20 ng/mL, you would recommend at least 3000 IU of daily vitamin D3 to
get the serum level close to 50 ng/mL.
Obesity suppresses the activation
of bioactive vitamin D. Weight loss will increase vitamin D levels and increase
its activity.
Vitamin D is not a cure all. However, it may be another useful tool in preventing metabolic dysfunction.
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Background: The role of
vitamin D in people who are at risk for type 2 diabetes remains unclear.
Purpose: To evaluate
whether administration of vitamin D decreases risk for diabetes among people
with prediabetes.
Data sources: PubMed,
Embase, and ClinicalTrials.gov from database inception through 9 December 2022.
Study selection: Eligible
trials that were specifically designed and conducted to test the effects of
oral vitamin D versus placebo on new-onset diabetes in adults with prediabetes.
Data extraction: The primary
outcome was time to event for new-onset diabetes. Secondary outcomes were
regression to normal glucose regulation and adverse events. Prespecified
analyses (both unadjusted and adjusted for key baseline variables) were
conducted according to the intention-to-treat principle.
Data synthesis: Three
randomized trials were included, which tested cholecalciferol, 20 000 IU (500
mcg) weekly; cholecalciferol, 4000 IU (100 mcg) daily; or eldecalcitol, 0.75
mcg daily, versus matching placebos. Trials were at low risk of bias. Vitamin D
reduced risk for diabetes by 15% in adjusted analyses, with a 3-year absolute
risk reduction of 3.3%. The effect of vitamin D did not differ in prespecified
subgroups. Among participants assigned to the vitamin D group who maintained an
intratrial mean serum 25-hydroxyvitamin D level of at least 125 nmol/L (≥50
ng/mL) compared with 50 to 74 nmol/L (20 to 29 ng/mL) during follow-up, cholecalciferol
reduced risk for diabetes by 76%, with a 3-year absolute risk reduction of
18.1%. Vitamin D increased the likelihood of regression to normal glucose
regulation by 30%. There was no evidence of difference in the rate ratios for
adverse events (kidney stones; hypercalcemia; hypercalciuria; death.
Conclusion: In adults
with prediabetes, vitamin D was effective in decreasing risk for diabetes.
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